Clinical Program Manager Consultant
1 week ago
The Clinical Program Manager Consultant will play a key role in supporting the overall Federal Employee Program (FEP) Care Management team as a subject matter expert, exemplifying Blue Shield of California leadership behaviors.
Key Responsibilities- Support the FEP CM team as a subject matter expert, providing guidance and expertise to ensure the team's success.
- Contribute to the adoption, evaluation, and ongoing improvement of Care Management electronic medical records (EMRs), ensuring seamless integration and efficient workflows.
- Participate in go-live testing to ensure the successful implementation of new EMR systems, collaborating with cross-functional teams as needed.
- Work to achieve operational targets defined by the Blue Cross Blue Shield Association (BCBSA), preparing and submitting Care Management data to meet regulatory requirements.
- Create and educate the team on specifications around Healthcare Effectiveness Data and Information Set (HEDIS) measures selected by the Office of Personnel Management (OPM), promoting data-driven decision making.
- Support team members through consistent and successful caseload management, workload distribution, and goal achievement, ensuring team success and regulatory compliance.
- Lead team huddles and meetings to facilitate process changes, encourage collaboration, and drive team performance.
- Contribute to departmental goals and planning efforts, influencing business unit performance and achieving Blue Shield of California objectives.
- Collect and analyze data required for contractual reporting, ensuring accurate and timely submissions.
- Provide guidance, coaching, and training to employees within the job area, promoting professional development and growth.
- Collaborate with the training department and operations team to customize training specific to the FEP team, enhancing knowledge and skills.
- Design and implement plans of care with targeted interventions, enhancing quality, access, and cost-effective outcomes, in collaboration with the HEDIS quality team.
- Develop and maintain working knowledge of regulatory and accreditation standards, ensuring compliance and excellence in care management.
- Certified Case Manager (CCM) Certification or eligibility to complete certification, demonstrating expertise in care management.
- Working knowledge of regulatory and accreditation standards, including NCQA and Case Management Society of America (CMSA) guidelines.
- Demonstrated ability to independently assess, evaluate, and interpret clinical information and care planning, ensuring high-quality patient outcomes.
- Proficiency with Microsoft applications, including Word, Excel, Outlook, and Teams, to support efficient workflows and data analysis.
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Program Manager Clinical, Consultant
3 weeks ago
Long Beach, CA, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Program Manager Clinical, Consultant
3 weeks ago
Long Beach, CA, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Program Manager Clinical, Consultant
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Long Beach, United States Blue Shield of California Full timeYour RoleThe Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the memberâs treating physicians. The Clinical...
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Program Manager Clinical, Consultant
3 weeks ago
Long Beach, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Program Manager Clinical, Consultant
3 weeks ago
Long Beach, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Long Beach, United States Blue Shield of California Full timeYour RoleThe Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Program Manager Clinical, Consultant
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Long Beach, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Program Manager Clinical, Consultant
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Long Beach, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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Program Manager Clinical, Consultant
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Long Beach, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member's treating physicians. The Clinical...
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Program Manager Clinical, Consultant
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Long Beach, CA, United States Blue Shield of California Full timeYour Role The Federal Employee Program (FEP) Care Management team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis by collaborating with members and those involved with their care including a multidisciplinary team and the member’s treating physicians. The Clinical...
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